Monday, January 16, 2012

Dual Diagnosis, Co-Occurring Disorder: How Bad Is it?

I just added two segments to my mcmanweb article, When Mood Meets Alcohol and Substance Use. The two segments help open and close the article, but surprisingly they work together as a blog piece without the intervening content. Without further ado ...

In the fall of 2011, I experienced an aha! moment into the true severity of this condition. I was having dinner with a group of individuals involved in NAMI (National Alliance on Mental Illness). NAMI was founded in the late seventies by parents with kids with schizophrenia and all these years later these individuals still form the core of the organization's membership.

Inevitably, the conversation turned to their kids. The intractable nature of their illness, the heartbreak they put their families through, hospitalizations, homelessness, run-ins with the law, on and on. Naturally, I assumed they were talking about schizophrenia. Then one parent mentioned bipolar, then another, then another.

Bipolar? For the most part, even those facing severe challenges manage to settle into some kind of quasi-life. Yes, all hell may occasionally break loose, but the emphasis is on occasional. What I was hearing was different, way different.

You guessed it. It wasn't "just bipolar" I was hearing about. Thanks to drug and alcohol abuse in the equation, life's degree of difficulty for all parties concerned went from "challenging" to "just about impossible." The stories that night jibed with other accounts I had heard over the years from parents and loved ones, plus no end of conversations I have had with individuals experiencing the condition.

How bad is it? Recall, at first I thought these parents were talking about schizophrenia. That's how bad it is. 

Many people I have met in DBSA support groups clearly benefit from also attending AA and NA, but there are limits to this type of divided support. The divide exists across clinical services, as well - with sharply segregated specialities operating in their own isolated silos - despite the fact that expert opinion strongly supports integrated treatment. How ridiculous is that? Consider this passage from Voltaire's "Zadig."

Zadig was more dangerously wounded; an arrow had pierced him near his eye, and penetrated to a considerable depth. ... A messenger was immediately dispatched to Memphis for the great physician Hermes, who came with a numerous retinue. He visited the patient and declared that he would lose his eye. He even foretold the day and hour when this fatal event would happen. "Had it been the right eye," said he, "I could easily have cured it; but the wounds of the left eye are incurable." All Babylon lamented the fate of Zadig, and admired the profound knowledge of Hermes.

In two days the abscess broke of its own accord and Zadig was perfectly cured. Hermes wrote a book to prove that it ought not to have been cured. Zadig did not read it ...

So here we are, our entire treatment and support system in a state of myopia, with doctors of the left eye and doctors of the right eye not talking to each other, totally blind to the real phenomenon - dual diagnosis, co-occurring disorder, whatever you want to call it. Again, how bad is it? Recall my aha! moment with those NAMI parents.  


Amelia said...

Thank you so much for sharing. A lot of people don't notice the other problem when there's a drug or alcohol addiction, even an eating disorder. It's super important to find a dual diagnosis treatment even if it's long term addiction treatment. Without fixing both problems, there will be a nasty cycle...dual diagnosis treatment saves lives.

tweet_sox said...

It is quite awaking when you see it through a concentrated lens. I am lucky /sarc/ enough to have a dual diagnosis and am in recovery w/ others in my profession. I was amazed at the numbers I joined after hitting bottom from self-medicating with substances. It's scarey to be in it alone. At least we got a diagnosis in the end.

Harry Geeman said...

Thanks for that post! For a long time I was caught in a trap of acceptance/denial of bipolar Or Alcoholic. I didn't want to accept I could possibly be Both. My experience of self medicating with alcohol (and sometimes drugs) was that I used them to Enhance symptoms rather than subdue them. IE: I used it to increase the high I already experienced with hypomania (actually I think mania, it was pretty self destructive).Alcohol seemed to have a Rocket Fuel like quality to it for me. Eventually I "got it" when it hurt badly enough & I accepted both conditions. A combination of psychiatric services, medication, recovery groups and self management seems to be keeping both demons at bay.But my experience is dual diagnosis requires dual recovery, however that might be achieved.Actually I'm surprised there are only two comments here, given the number of us bipoholics out here. I'm always surprised when i announce my bipolarity in a recovery meeting as a fair proportion of the room will say "yeah and..?"